Liver failure and transplantation after itraconazole treatment for toenail onychomycosis

Abstract

Three weeks after completing a 4-pulse course of itraconazole for toenail onychomycosis, a 25-year-old woman patient developed severe liver crisis and required an emergency liver transplant. We report the case and discuss the use of itraconazole in onychomycosis and dermatomycoses.

Itraconazole-Induced Cholestasis: Involvement of the Inhibition of Bile Canalicular Phospholipid Translocator MDR3/ABCB4

“…Furthermore, in paInhibition of MDR3/ABCB4 by Itraconazole tients 1 and 2, serum ITZ concentrations were significantly high, which should increase the risk of hepatotoxicity. Patients 1, 2, and 3 suffered from ITZ-induced liver injury 62, 20, and 2 days after starting ITZ-administration, respectively (Table 1), which is consistent with the previous report that the time period to exhibit elevations in LFTs after starting ITZ administration varied from several days to several weeks in ITZ-induced liver injury (Lavrijsen et al, 1992;Hann et al, 1993;Gallardo-Quesada et al, 1995;Srebrnik et al, 2005). In the present study, day 0 was defined as the day on which ITZ administration was started for patients 1 and 2.…”

“…ITZ has been reported to cause cholestatic liver injuries (Lavrijsen et al, 1992;Hann et al, 1993;Gallardo-Quesada et al, 1995;Srebrnik et al, 2005), and our clinical data also suggested a cholestatic effect of ITZ with elevations of ALP, ␥-GTP, and direct bilirubin (Fig. 1).…”

“…According to the previous reports, ITZ-induced liver injury was associated with significant elevations of ALP, ␥-GTP, and total bilirubin, which suggest the cholestatic effect of ITZ (Lavrijsen et al, 1992;Hann et al, 1993;Gallardo-Quesada et al, 1995;Srebrnik et al, 2005). In addition, the liver biopsy specimens from patients with ITZ-induced liver injury showed histological patterns of cholestasis (Adriaenssens et al, 2001).…”

“…Concerning the clinically observed drug-induced cholestasis, an antifungal agent, itraconazole (ITZ), has been reported to cause cholestatic liver injuries (Lavrijsen et al, 1992;Hann et al, 1993;Gallardo-Quesada et al, 1995;Srebrnik et al, 2005). In addition, the U.S. Food and Drug Administration has received reports of at least 24 cases of DILI, including 11 deaths associated with the use of ITZ (Song and Deresinski, 2005).…”

Efficacy and safety of itraconazole pulses vs. continuous regimen in cutaneous sporotrichosis

“…Itraconazole pulse therapy was safe, at present there were only two reports of life-threatening hepatitis after itraconazole pulse therapy. 22,23 In our study, one patient (4.5%) developed slight facial oedema and none experienced severe side effects or laboratory abnormalities. But there were no significant differences between the rates of side effects of the two groups.…”